Quality or quantity? Serious illness prompts serious discussion
Some doctors are reluctant to recommend palliative care, particularly for patients who are younger than 65 and dealing with a serious illness.
The shift from lifesaving treatment to comfort care may seem like admitting the futility of the situation.
That would mean admitting the futility of the situation, considering the patient‘s quality of life and its length, and perhaps shifting efforts from life-saving to comfort care.
“It‘s understandable” that doctors may wish to avoid such conversations, says Ajeet Gajra, MD, a medical oncologist at Upstate who researches the utilization of palliative care. “The doctor may know there are no other meaningful treatment options but is afraid to say that to the patient and the family.
“It‘s a difficult discussion for the doctor, patient and family, so it‘s often avoided. Patients may feel that the doctor is ‘giving up‘ on them. It is important to have an open discussion about the patient's hopes and wishes in the context of a limited prognosis. It is important for patients to realize that such a recommendation is being made because further treatment will cause more harm than good and that the doctor cannot put the patient knowingly in harm's way.”
The discussion may be that much more difficult when it centers on a young patient. Regardless of the patient‘s age, Gajra says, education and information regarding palliative care should be offered early in the course of an incurable cancer. That way the patient and loved ones do not feel blindsided in the course of their fight if it‘s clear that medical treatments will not help further. The patient or their loved ones can bring up a discussion regarding palliative care if the doctor does not.
In a paper published in the Journal of Geriatric Oncology this year, Gajra and four colleagues from Upstate studied the medical records of veterans with advanced cancer near the end of life. They compared those older than 65 with those from 40 to 65 years of age and discovered the older veterans were referred to palliative care an average of 12 days sooner than the younger. Younger veteran' average time in hospice care was 13 days longer.
Gajra says other studies show that patients may have a better quality of life if they are in hospice care at their homes, rather than hospitalized in an intensive care unit, or seeking emergency care for each medical setback.
Studies also show that while timely palliative care enhances a patient‘s quality of life, it can actually extend his or her length of life.
Palliative care focuses on providing relief from symptoms of serious illness, rather than trying for a cure or recovery. Similarly, hospice care is meant to keep patients comfortable and pain-free during advanced illness. Both are designed to improve the quality of life for the patient and his or her loved ones.
Palliative care is an option for adults and children who are treated at Upstate University Hospital. Referrals are also routinely made to Hospice of Central New York. An outpatient palliative care program for adult patients with advanced cancer will start this fall.
This article appears in the summer 2016 issue of Cancer Care magazine. Hear an interview with Judy Setla, MD, medical director of Hospice of CNY, about hospice and palliative care.